Department of Health

Republic of the Philippines

National Standards and Implementation Guide

for the Provision of
Adolescent-Friendly Health Services

September 9, 2010
 TABLE OF CONTENTS

I. Introduction
1.1. Background Information
1.2. Rationale
1.3. Intended Users of the Manual
1.4. Health Outcomes to be Achieved
1.5. Service Package
1.6. Health Service Delivery Points
1.7. Service Providers

II. Standards for Adolescent-Friendly Health Services

2.1. Standard 1
2.2. Standard 2
2.3. Standard 3
2.4. Standard 4

III. Criteria of the Quality Standards of Adolescent-Friendly Health Services

and Implementation Guide

IV. Implementing Mechanisms at Various Levels

V. Monitoring and Evaluation of the AFHS Quality Standards

References

Annexure
I. Introduction

1.1. Background Information

Adolescents (10- 19 years age group) constitute 22.3% of the population and young people 10 –
24 years of age account for 30.3% of the country’s total population (NDHS, 2008). The youth
(15 – 24 years), on the other hand, comprise 20% of the population with an annual growth rate of
2.1 (YAFS 3, 2002). They face many health and development problems (substance use and
alcohol consumption, STI/HIV/AIDS, unwanted pregnancies, nutritional deficiencies, etc) which
today affect their lives adversely.

A little less than half (47%) of young people have tried smoking with males being more prone to
cigarette smoking than females. However, the prevalence of smoking among young females
almost doubled from 17% to 30% in 1994 and 2002 respectively. The proportion of young
people who tried drinking alcohol is about 93% in males. Like smoking, the proportion showed
an increasing trend among the female populace (54% in 1994 and 70% in 2002). Although the
proportion of young people exposed to drugs is significantly lower compared to smoking and
alcohol, the proportion doubled from 6% in 1994 to 11% in 2002. Those who smoke, drink and
use drugs are more likely to have sex.

The YAFS 3 (2002) data showed that one in three of young people think that it is alright for
young men to engage in premarital sex while the approval rate for young women is lower at
22%. A comparison of the results of YAFS 2 and 3 showed an increasing tolerance for women
engaging in pre martial sex – 13% and 22% in 1994 and 2002 respectively. With regards the age
of first sexual intercourse, the 2008 NDHS showed that among women 15 – 49 years old, 3%
had their first sexual intercourse by age 15; 37% by age 19; 57%by age 22 and 71% by age 25.
In addition, 10% of 15-19 years old have begun childbearing (NDHS, 2008). Around 23% of
Filipino youth had premarital sex (2002). This is higher than the 18% in 1994. One out of three
youths admitted to having more than one sexual partner beside their first sexual partner.

STI and HIV are issues of concern in the country. The YAFS 3 (2002) survey showed that
although awareness about STIs is increasing, misconceptions about AIDS appear to have the
same trend. The survey also showed that Filipino males and females are at-risk of STIs,
HIV/AIDS. 62 % of sexually transmitted infections affect the adolescents (YAFS 3, 2002) while
29 % of HIV positive Filipino cases are young people. Awareness of AIDS for both sexes was
near universal (85%) but misconceptions on its curability have deteriorated. The proportion of
those who think AIDS is curable more than doubled (from 12% in 1994 to 28% in 2002). Many
adolescents also resort to services of unqualified traditional healers, obtain antibiotics from
pharmacies or drug hawkers or resort to advices from friends (e.g. drinking detergent dissolved
in water) without proper diagnosis to address problems of STIs. The newly reported HIV cases
among 15-24 years old increased sharply from 41 to 218 in 2007 to 2009 (National AIDS
Registry, NEC, DOH).
1.2. Rationale

In line with the above concerns of the adolescents, several initiatives were undertaken. In line
with the Adolescent and Youth Health Policy (Department of Health, Administrative Order No.
34-A, s. 2000), A Guidebook on Adolescent and Youth Health and Development Programme
was developed by a multi-sectoral body headed by the Department of Health and supported by
the United Nations Population Fund (UNFPA). However, during its implementation (from 2002
to the present), a huge gap developed between the guidelines and their actual use. Adolescents
and the youth have limited access to RH services that meet the standards of quality care, user
friendly and culture sensitive. Despite the evidence presented in policy documents, most services
continue to target adults or children. Thus, these fail to meet the special needs of the youth
especially in terms of confidentiality, privacy, accessibility and cost. There is only a handful of
health care providers trained to cater to the special needs of the youth. There are also missed
opportunities for prevention of health problems because young people are unwilling to utilize
available health services. Often, due to insufficient knowledge transfer, new or updated practice
guides were not systematically introduced and promoted to improve health service delivery or to
advocate for the application of models of best practices. In addition, since most programs were
initiated by non-governmental agencies and the private sector, they were limited in coverage and
sustainability. Correspondingly, in reference to the Adolescent and Youth Health Program
Implementation Review held in January 2009, the recommendation was to establish standards on
adolescent-friendly health services.

1.3. Intended Users of the Manual

This document outlines the four national standards for provision of Adolescent-Friendly Health
services and the steps required to implement the standards. It is expected that this document will
guide program implementers at various levels in providing adolescent-friendly health services.
The document is also expected to be used by planners and policy makers.

1.4. Health Outcomes to be Achieved

1. Healthy Development
a. Promote healthy development
b. Reduce the health and social consequences when developmental problems
occur.
2. Healthy Nutrition
a. Improve healthy nutrition
b. Reduce under/over nutrition
c. Reduce the health and social consequences of over/under nutrition.
3. Sexual and Reproductive Health
a. Reduce too early, unwanted pregnancy
b. Reduce morality and morbidity during pregnancy, child birth,
c. Reduce Sexually Transmitted Infections/Human Immunodeficiency Virus
(STI/HIV)
d. Reduce health and social consequences of STI / HIV infection when they
occur
 4. Substance use
a. Reduce substance use
b. Reduce the health and social consequences of substance use
5. Injuries
a. Reduce injuries
b. Reduce health consequences (mortality and morbidity) and psychosocial
consequences when injuries occur.
6. Violence (All Forms)
a. Reduce all forms of violence
b. Reduce health consequences (mortality and morbidity) and psychosocial
consequences when violence occurs.
7. Mental Health
a. Improve mental health and well being
b. Reduce mental health problems
c. Reduce the health and social consequences when mental health problems
occur.

1.5. Service Package

Based on the national objectives and strategic thrusts of the Department of Health, Philippines,
the following Adolescent Core Package has been proposed for implementation:

CORE PACKAGE OF SERVICES

Key Services Objective of the Package

A. Basic Essential Health Package 1. To provide basic health care and
management to all adolescents
2. To identify the most common health
concerns and issues among adolescents
3. To screen all adolescents for risk-taking
behaviors
4. To render preventive health management and
counseling to all adolescents, including on
substance use, sexuality, violence and injury
prevention, and for improving mental health
B. Adolescent Pregnancy Package 1. To reduce rates of adolescent pregnancy
through comprehensive health package
2. To reduce mortality and morbidity brought
about by adolescent pregnancy and
puerperium
C. Sexually Transmitted 1. To reduce morbidity and mortality brought
Infections/HIV Packages about by STIs and HIV
2. To prevent STIs/HIV and its complications
Source: Manual of Standards for Adolescent-Friendly Health Services, DOH, 2008
The core package will be made available from Rural Health Unit (RHU. However, the district,
provincial and tertiary level hospitals will provide services in other areas including substance
use, sexual abuse and sexual violence and mental health. They will also cater to clients and
patients referred from RHU and BHS.

1.6. Health Service Delivery Points

The services will be given at the following health service delivery points: Retained hospitals /
provincial / district hospitals, Rural Health Unit. Innovative mechanism for utilization of other
facilities, including but not limited to social hygiene clinic, schools, “one-stop-shops”,
workplace, shopping malls, sports centers, youth hang-outs, will be utilized by the government in
coordination with non-government and other private institutions.

1.7. Service Providers

The following health providers, both at the health and non-health sectors at the above-mentioned
health service delivery points which include doctors, nurses, and midwives (DOH AO 34-A) will
provide the services. Community-based volunteers, peer group leaders, psychologists and
counselors and other staff (e.g. pharmacists and others) will also provide appropriate services
depending upon the circumstances.
II. Standards for Adolescent-Friendly Health Services (AFHS)

The right to health, according to the UN Committee on Economic, Social and Cultural Rights,
consists of six normative elements namely health availability, health physical accessibility,
health economic accessibility, health information accessibility, health acceptability and health
quality (see Annex 3: Guiding Principles). WHO’s criteria for adolescent-friendly health services
include services being equitable, affordable, acceptable, adequate, comprehensive, effective, and
efficient (See Appendix 4: Standard and Criteria Definitions).

Cognizant of the right of the adolescent to the highest attainable standard of health through
improved access and utilization of health services and the WHO criteria for provision of
Adolescent Friendly Health services, the Philippines adopts four national standards for the
provision of Adolescent-Friendly Health Services:

Philippines National Standards for Adolescent-Friendly Health Services:

A standard is a statement of desired quality. The four quality standards for provision of
Adolescent-Friendly Health Services (AFHS) were developed to ensure that adolescents will be
able to enjoy a variety of facilities, goods, services and conditions necessary to realize the
highest attainable standard of health. These standards are in line with the WHO's criteria for
Adolescent-Friendly Health Services and with the policy documents that exist in the country.
These standards will also apply to health services that address the needs of youth.

Standard 1 "Adolescents in the catchment area of the facility are aware about the health services
it provides and find the health facility easy to reach and obtain services from it".

Standard 2 “The services provided by health facilities to adolescents are in line with the
accepted package of health services and are provided on site or through referral linkages by well-
trained staff effectively”.

Standard 3 “The health services are provided in ways that respect the rights of adolescents and
their privacy and confidentiality. Adolescents find surroundings and procedures of the health
facility appealing and acceptable”.

Standard 4. “An enabling environment exists in the community for adolescents to seek and
utilize the health services that they need and for the health care providers to provide the needed
services”.

The standards criteria were developed keeping in view the necessary resources, operational
activities and the expected outcomes. The National standards will ensure that services being
provided to the adolescents are uniform across all the service delivery points and are relevant to
the present day needs of the adolescents. It is expected that adhering to the laid down standards
would improve the utilization of such services.
III. Criteria of the Quality Standards of Adolescent-Friendly Health Services
(AFHS) and Implementation Guide

Standard 1: "Adolescents in the catchment area of the facility are aware about the health
services it provides and find the health facility easy to reach and obtain services from it."

Rationale: Adolescents are generally not aware about the availability of health services that
cater to their needs. They either do not know about the location of the facility that provides
health services in an adolescent friendly manner or the type of services that are available from
the facility. Thus despite the availability of these services and competent personnel to provide
such services, there is a low utilization rate of such services. Some of the reasons for low
utilization could be the lack of informational activities to promote the adolescent services
provided by these facilities; accessibility of the facility in terms of distance, cost and time; or the
affordability of services. Actions are to be taken to ensure that adolescents are well-informed
about the availability of health services.

Input Criteria Process Criteria Output Criteria

I1.1. - There is a well-defined P1.1.-Activities to inform Adolescents are aware about
plan to inform adolescents in adolescents about the the type of services from the
the community as to the availability of services from health facility, their working
availability of services from the facility are carried out as days and hours and know that
the facility per the existing plan. they are welcome.
I1.2. - Health facility has a
signboard which indicates
-the type of health services
that are provided
-when they are provided
-that adolescents are welcome
I1.3. -Flexible time schedule P1.3.- Health services are
for adolescent clients, if provided as per the flexible
possible, is in place, time schedule
I1.4. -Policies and procedures P1.4. -Service providers
to provide health services to provide adolescent with
adolescents free of charge or services free of charge or at
at affordable prices are in affordable prices in line with
place. the policies and procedures.
I1.5. -A plan to provide P1.5. -Outreach services are
outreach health services to being delivered to special
adolescents, particularly those groups of adolescents as per
belonging to special groups in the plan.
the catchment area of the
health facility, is in place
Implementation Guide:

1.1. Elements of a plan to inform adolescents. The IEC plan should contain the activities for
information dissemination, place and time frame that they will be conducted, persons
responsible, the resources needed, as well as the evaluation indicators and methods. In terms
of activities, the facility may conduct periodic community sessions, information
dissemination activities in schools especially during home room period, produce and post
billboards in community areas being frequented by community residents especially the
adolescents, and seminars in schools during special occasions. Posters containing the
services in the facility may also be posted in strategic locations in the community. The
information material, such as flyers, which can be distributed to adolescents during
community festivities, after school hours, and in malls where adolescents usually go to,
should contain the services available, time and place where these are available as well as the
contact persons. Linkages with ongoing programmes of various departments can be
established and, if available, "peer group workers" and volunteers of various health
programmes should be informed about the services.

1.2. Appropriate signboard. The facility is to have an appropriate signage in the health facility
reflecting the services being provided and when they are provided. Tarpaulin, banners or
posters stating that adolescents are welcome in the facility are posted/placed in an area in the
facility that can easily be read by the adolescent clients.

1.3. Use of a flexible time schedule. It is advisable to have facility timings that suit the needs
of the adolescents. In government-owned and operated facilities, services are offered on the
usual schedule which is 8:00 AM to 5:00 PM. However, some private and non-government
facilities should have flexible time schedule so that they can cater to the needs of
adolescents who may be engaged in other activities during the 8:00 AM to 5:00 PM
schedule. The services could be offered from 7:00 AM to 10:00 PM, on a 24-hour basis,
Saturdays and Sundays in these facilities.

1.4. Provision of 'free' health services. Government facilities offer health services to
adolescents without any charges. As much as possible, services for adolescents should be
given for free from other facilities, too. However, considering the expenses incurred for the
maintenance and improvement of the facility vis-a-vis the budget given for the operation of
these facilities, LGUs may resort to cost-sharing schemes. The amount to be paid should be
by consensus and reached through consultations with different stakeholders including the
clients, services providers, representatives from agencies concerned with adolescent care,
community and even the government through the barangays. The cost of services and/or
commodities will be posted in strategic places to inform the clients, general population and
all stakeholders.

Private and non-government organizations may also institute schemes to sustain the
operations of their facilities. Some of their services can be availed by adolescent clients at
affordable prices or in a subsidized form.
1.5. Elements of a plan to provide outreach services to adolescents. Outreach services are
needed to provide services to follow-up outcome of cases and / or defaulters, adolescents as
the "first contact" services in hard to reach areas and / or clients with special needs, cater to
special circumstances (i.e. victim of abuse/violence, etc). These outreach activities should be
planned. The plan should include the date and time, place, the personnel to conduct
outreach, the services to be given, resources needed, other agencies involved (if any) and the
assistance that these agencies/organizations will provide. The outreach provider must have
the necessary supplies.

Outreach activities may include periodic health check-ups, mobile clinics, community health
camps, education sessions utilizing the available IEC material, home visitation, and use of
traditional media such as puppet shows and psychodrama. The provider should develop and
maintain linkages with peer educators, volunteers, school teachers, school physicians and
school nurses (where available), personnel from youth centres and other relevant agencies
and develop joint activities to provide services. The provider should link up with schools to
organize "question box" activities in the schools. The general questions could be taken up
during the school health assembly.
Standard 2: “The services provided by health facilities to adolescents are in line with the
accepted package of health services and are provided on site or through referral linkages by well-
trained staff effectively”.

Rationale: Some of the health needs of adolescents may appear to be similar to those of adults
(Example: ANC services, services for STIs, etc) yet the unique characteristics of this age group
in terms of their physical, physiological, psycho-emotional, and even socio-cultural aspects
necessitates that the needed services be provided in line with the required package effectively. In
many cases the services that meet the adolescents' needs are either not fully provided from the
health facilities or the services that are provided are not effective. This standard ensures that
protocols, guidelines as well as services as per the accepted package that cater to the special
needs of individuals in this age group are available from the designated health facilities.

This standard also ensures that the staff of adolescent-friendly health facilities possesses the
necessary knowledge, attitude, skills and behavior to deal with their target clients

Input Criteria Process Criteria Output Criteria

I2.1. -An agreed upon P2.1. - Services provided / The services provided by the
'package' of services to be delivered on site or through health facilities are effective
provided to adolescents is in referrals are based on the and in line with the accepted
place. agreed upon adolescent health package of services, and are
package provided on site or through
referral linkages by well
I2.2. -An agreed upon list of P2.2. -The essential trained staff. The adolescents
essential commodities and commodities and supplies as find the services to be in line
supplies is in place per the agreed upon list are with the defined package of
available and are provided to services.
adolescents.

I2.3. -A focal person has been P2.3. -The focal person

designated for provision of actually provides services to
adolescent-friendly health adolescents either at the
services. facility or through referral and
coordinates other activities.
I2.4. -Service Providers have P2.4. -The facility staff utilizes
been trained / oriented for the their competencies to provide
provision of AFHS and are health services effectively and
competent in managing competently.
adolescent clients and
providing guidance to their
parents.
I2.5 -Protocols / guidelines to P2.5. -The service providers
provide services competently follow the protocols
in non judgmental, caring, /guidelines to provide services
considerate, and gender and competently and with a non-
culturally-sensitive attitude judgmental, caring, considerate
and manner are in place. and gender and culturally
sensitive attitude and manner
I2.6. -Clinical management P2.6. -The service providers
 guidelines for the provision of follow the clinical guidelines
the specified health services for provision of services.
are in place
I2.7. -A resource directory of P2.7.-The resource directory is
organizations and referral utilized to refer the needy
networks providing health adolescents for the particular
services that are not provided services that are not available
at the facility is available. at the facility.

I2.8. -Appropriate forms for P2.8. -The appropriate forms

referral and feedback are are utilized for referral and
available feedback

Implementation Guide:

2.1. The package of health services to be provided. The list of essential health services to
be provided to the adolescents as packages include basic essential health package, adolescent
pregnancy package and STI/HIV package. The components of the package may be modified
in the future as evidence for specific components are updated periodically by the Department
of Health.

Package of Services Specific Services

Basic Essential Health
Package
General Health Assessment – History (HEADSS) and Physical
Examination, including blood pressure measurement, vision and
hearing screening
Dental Assessment
Psychosocial Risk Assessment and Management
Nutrition Assessment and Counseling
Micronutrient Supplementation- Iron and Folic Acid
Immunization – TT, MMR, Hepatitis B
Basic Diagnostic Tests (CBC, Urinalysis, Fecalysis, sputum
PPD)
Reproductive Health Assessment and Counseling
 Fertility awareness, menstrual health issues and counseling
 Pap smear and pelvic exam if sexually active
 Adolescent male reproductive health issues
 Gender issues
Voluntary Testing for STIs /HIV
Adolescent Pregnancy
Package
Prenatal visits
 History and Physical Examination
 Immunization – Tetanus toxoid
  Micronutrient supplementation with iron, folate
 Psychosocial risk assessment
 Laboratory – CBC, blood typing (if not available, refer),
pregnancy test, urinalysis
 Pregnancy counseling
 Nutrition counseling
 Birth plan including exclusive breastfeeding counseling
 Family planning counseling
Natal (Birthing Homes)
 Safe delivery by skilled health worker at a mother-and baby
friendly health facility
 HBsAg test for pregnant mothers
 Essential Newborn Care Protocol
 Newborn package:, Vitamin K, Hepatitis B – birth dose,
BCG, eye prophylaxis, Newborn Screening
Postnatal Visits
 Micronutrient Iron supplementation
 Counseling services: Family planning, Nutrition counseling,
Exclusive Breastfeeding, Parenting
Sexually Transmitted
Infections/HIV Packages
History and Assessment Forms
Diagnostics: Grams Stain, RPR, C/S, Pap smear, HIV
Counseling
Psychosocial risk assessment
Management, Treatment and Counseling

2.2. Essential medicines, equipment and supplies. At the minimum, the following basic
medicines, equipment and supplies needed in the provision of services should be present:

Essential Resources
Basic Essential Health Package
Writing materials, Individual Treatment Record Forms (ITR),
Dental mirror, Dental record form, Dental Equipment
Psychosocial Risk Assessment Form
BP apparatus, Adult weighing scale, tape measure, height chart, orchidometer, dietary
prescription form, exchange list
Iron with folic acid tablets
Vaccines: Tetanus toxoid, MMR, Hepatitis B
Centrifuge, heparinized capilet, microscope, syringes and needles, cotton, alcohol, slides,
cover slip, vaginal speculum, cotton pledget
ITR, Reproductive Health Assessment Checklist, Flipchart on reproductive health
HIV testing kit, microscope, glass slides, reagents for Gram’s stain
Adolescent Pregnancy Package
ITR, FP flipchart, iron tablets, blood typing and Rh sera, pregnancy test, centrifuge,
microscope, TT vaccine, syringes, cotton balls, alcohol, FP commodities
HBsAg reagent, birth plan form, NBS kit, BCG, Hepatitis B vaccine, delivery table, sterile
scissors, gloves, cotton, alcohol, plastic clamp, equipment and supplies as per BEmONC
guidelines
Iron tablets and vitamin A capsules, FP flipchart, FP commodities, Breastfeeding chart, diet
plan
Sexually Transmitted Infections/HIV Packages
ITR
Reagents for Gram’s stain, RPR, Glass slides, microscope, cotton pledgets
Counseling Cards or Chart

2.3 Focal person in the health facility. The facility must have a designated focal person
who will render services to adolescent clients and coordinate within and outside the facility.
She / He should be oriented by attending orientation /training programs on dealing with
adolescent clients such as the Orientation Program on Adolescent Health and Adolescent Job
Aid (AJA). The focal person must provide the services to adolescents either at the facility or
through appropriate referral and coordinate with parents, opinion makers and institutions –
educational, NGOs, community-based organizations, media and with referral institutions.

2.4 Capability building for AFHS service providers. It would be preferred that like the
focal person in the facility, other service providers who are likely to deal with adolescents
must have the competencies to deal with adolescents and their health needs effectively. They
should attend capability building programs so that they can deal effectively with their
adolescent clients. Programs include Orientation Program on Adolescent Health, Orientation
on Standards and Implementation Guide for AFHS, Adolescent Job Aid.

2.5 Dealing in a non-judgmental and caring manner with adolescents. The adolescent
client should be dealt with respect and shown all courtesies that are due to a human being.
Facility staff should be polite and considerate and avoid making any hurtful or damaging
remarks for what so ever reason. Service providers must cultivate a non-judgmental attitude
and not deprive adolescents from appropriate services on extraneous grounds including those
on gender, education, social class, marital status, religious and political beliefs, and
orientation. They should deal with adolescents sensitively and in a caring and considerate and
gender and culturally-sensitive manner. Clinic Rooms must have window curtains and a bed-
screen surrounding the examination tables. Nobody else should be allowed to enter the room
when the client is already there, in order to ensure privacy. Confidentiality policy of the
clinic should be displayed and clearly expressed to the client and the individuals
accompanying them in the first session itself.

2.6 Clinical management of adolescents. The Adolescent Job Aid (AJA) that was
developed by a multi-sectoral group spearheaded by the DOH will be used for the common
conditions of adolescents. The service provider should also refer to other relevant clinical
 guidelines (STI, management of specific conditions, general guidelines) that are periodically
issued / circulated by DOH.

2.7 Resource directory of individuals/organizations and referral networks. All facilities

must develop a resource directory that should contain contact details of the relevant
institutions and individuals. The resource directory should include the names of the
organization/individual, address, contact person as well as contact details including the
telephone numbers, email address or websites

The national level Resource Directory is being provided.

Resource Directory of Individuals and Organizations

# NAME / COMPANY / ORGANIZATION / CONTACT DETAILS

POSITION COMPLETE ADDRESS

1 Maristela P. Abenojar Philippine Nurses Association (PNA) DL/ 5361888

1663 F.T. Benitez Street F/ 5251596
Malate, Manila M/ 09273448505
e-mail/ maris_presto@yahoo.com.ph
2 Jill S. Alvarez / FAD, Inc. DL/ 4001827 / 5250428
Program Manager 1066 Remedios Street corner San F/ 4001827
Bartolome Street M/ 09155196598
Malate, Manila 1004 e-mail/ fadthqctrl@pldtdsl.net /
jill.alvarez@gmail.com

3 Elmer M. Angus, M.D. / Philippine Academy of Physicians in DL/ 5243011 local 4410
Immediate Past School Health, Inc. (PAPSHI) F/
President M/ 09209540992
e-mail/ macarthur_52@yahoo.com
4 Pamela Averion / UNFPA DL/ 9010328
National Programme Gender & Culture and ARH F/ 9010348
Officer M/
e-mail/ averion@unfpa.org
5 Marciano Fidel L. Private School Health Officers Association DL/ 7315127 local 111
Avendaño / c/o Lourdes School Quezon City F/ 7315127 local 119
President Don Manuel corner Kanlaon Street, Sta. M/ 09177938846
Mesa Heights, QC e-mail/ dr_jun_avendano@yahoo.com
6 Edna A. Beguia / IMAP, Inc. DL/ 7244849 / (042) 3311311
PRO Pinaglabanan Street corner Ejercito Street, F/ 7275225 / (042) 5366353
San Juan City M/ 09053440173
Brgy. Kiloloron, Real, Quezon e-mail/ edna_beguia@yahoo.com

8 Deborah B. Cabanag NAPC Youth & Students DL/ 4265028

3rd Floor ATI Building, Elliptical Road, F/
Quezon City M/ 09182567492
e-mail/ debbie_cabanag@yahoo.com
9 Marlene de Castro / Baguio Center for Young Adults, Inc. DL/ (074) 4450623
Executive Director 33 Assumption, Baguio City F/ (074) 4428193 (telefax)
M/ 09189102124
e-mail/ mbdc_bcya@yahoo.com.ph
10 Jonathan D. Chua NAPC-YSSSC DL/
F/
M/ 09288571932
e-mail/ jonathanchua_02@yahoo.com
11 Gloria Cirineo AFRHS Network DL/ 8205215
F/
M/
e-mail/ gloriacirineo@yahoo.com

12 Erlyn Della-Caparro, Society of Adolescent Medicine of the DL/ 4948298

M.D. Philippines, Inc. (SAMPI) F/
 M/ 09238115729
e-mail/
13 Moses de Guzman / SAMPI DL/ 9246601 local 272
Adolescent Medicine Bahay ng Alumni F/
Specialist University of the Philippines M/ 09195872444
Diliman, Quezon City e-mail/ dittsdeguzman@yahoo.com

14 Robinson F. Espinoza / National Youth Commission DL/ 7812373

Chief of Policy and 373 Quezon Ave., Quezon City F/ 7812373
Planning Division M/ 09189217915
e-mail/ robin_espinoza@yahoo.com
15 Denia Gamboa / Council for the Welfare of Children DL/ 7811039 local 1006
Head, Public Affairs 10 Apo Street, Sta. Mesa Heights F/ 7811039 local 1006
and Information Office Quezon City M/ 09294208481
e-mail/ denia_3154@yahoo.com
16 Dexter M. Garcia / TRIDEV Specialists Foundation DL/
Project Officer F/
M/ 0917-8512782
e-mail/ dexgarcia@hotmail.com

17 Dr. Arvin Marbibi AFRHS Network DL/

F/
M/
e-mail/
18 Robert T. Mendoza / Philippine League of Government and DL/
President (Hospital Private Midwives, Inc. F/
Based) M/ 0908-933-1659, 0908-7110805
e-mail/
19 Dr. Rosa Maria H. PGH-Society of Adolescent Medicine of the DL/ 9316251 / 9315898
Nancho Philippines, Inc. (SAMPI) F/ 3733461
M/ 09178294968
e-mail/ rosenan830@yahoo.com
20 Lita Orbillo / NCDPC-DOH DL/ 7329956
Nurse VI F/ 7114846
M/ 09185836580
e-mail/ litaorbillo@yahoo.com

21 Dr. Luz P. Revita Philippine Academy of Physicians in DL/920-1342

School Health, Inc. (PAPSHI) F/ 928-6051
M/ 0922-8309044 or 0918-9309041
e-mail/ lprevita@yahoo.com

22 Ma. Loida Y. Sevilla / Plan International, Philippines DL/ 817-3187

Country Health 104 Salustiana Ty Tower F/ 840-3940
Advisor Paseo de Roxas Ave., Makati City M/ 0917-5012145
e-mail/ malou.sevilla@plan-international.org
23 Cherryl Mendoza Adolescent Wellness Center T/635-6789
Nurse Teen Health Hub By Appointment
The Medical City
Ortigas Avenue, Pasig City
24 Dr. Alicia Tamesis Teen Republic T/924-6601
Philippine Children’s Medical Center Loc 234 and 294
Quezon Avenue, Quezon City

2.8 Referral form. A referral form which contains the name of the referring facility and
service provider, client’s details (name, age, address), history of present condition,
physical/laboratory findings if appropriate, name and address of the facility where the client
is to be referred, and reason for referral must be in place. A return referral form should be
present and the client be instructed to bring this back to the referring facility. The referral
form should be sealed in envelope and addressed to the service provider of the facility to
which the client is being referred to. All referrals made and their outcome should be listed in
a referral logbook that should be maintained at the facility.
 Sample Referral Form

REFERRAL FORM
(To be left in the Referral Facility)
Reference number ----
Name of Referring Facility:
Address: Tel No:
Name/Position of Service Provider Referring: Date of Referral:

Name of the facility to which the client is being referred :

Name of Client: Age:

Address:

Reason for Referral:

Brief History (Include pertinent PE and laboratory findings and actions taken, if any.)

Clinical Impression:
Signature of Person Referring Signature Over Printed Name
of Client/Guardian:

REFERRAL RETURN SLIP

(Please cut and instruct patient/guardian to deliver back to Referring Facility)
Reference Number -----
Name of Referral Facility:
Address: Tel No:
Name/Position of Person Who Attended to the Patient: Date Seen:

Final Diagnosis:
Actions Taken (Include results of laboratory/ancillary procedures done and
management)

Follow up advice:

Signature of Person Who Attended to Signature Over Printed Name

the Patient: of Client/Guardian:
Standard 3 “The health services are provided in ways that respect the rights of adolescents and
their privacy and confidentiality. Adolescents find surroundings and procedures of the health
facility appealing and acceptable”.

Rationale: Adolescents will not seek services if the physical environment and procedures are not
appealing to them. While ensuring the adolescents’ comfort and ease at the facility, it is crucial
that the privacy and confidentiality of adolescents should be preserved and maintained
throughout. Aside from the quality of services and attitude of personnel, the condition and
features of the facility will also help contribute to client satisfaction and quality of care. It is
important to get feedback, suggestions and recommendations from adolescents to be able to
design facilities, procedures and protocols that will appeal to adolescents as well as suit their
needs and taste.

Input Criteria Process Criteria Output Criteria

I3.1. –Standard operating protocols P3.1 - Facilities are maintained / Adolescents feel
(SOP) to maintain a good ambience provided as per the SOP comfortable when they
for adolescents - including a clean visit health facility and
spacious waiting area, potable find the surroundings and
drinking water, clean toilets and procedures appealing and
educational material are in place acceptable.
I3.2. -The confidentiality and privacy P3.2. -Health facility displays the
policy of the facility is clearly confidentiality and privacy policy
displayed in the clinic and is clearly and adolescents and parents and
expressed to the client and their accompanying adults are informed
parents or accompanying adults. about it at all available opportunities.
I3.3. -Health facility procedures to P3.3. -Health facility staffs apply the
ensure confidentiality of the procedures to ensure the
adolescent clients and their parents confidentiality of their adolescent
are in place. clients and their parents.

I3.4. -Health facility procedures to P3.4. -Health facility staffs apply the
ensure privacy for the adolescent procedures to ensure privacy for
clients and their parents are in place. their adolescent clients and their
parents. (including private room for
consultation, simplified registration
process)
I3.5. -Protocols for the staff to P3.5. -Service providers follow the
provide services in a friendly and protocols to provide services to
appropriate manner are in place adolescents in a friendly and
appropriate manner.
I3.6. -Mechanisms to involve P3.6. -Adolescents are kept involved
adolescents in the designing, in designing, provision and
assessing and provision of health assessment of health services
services are in place
I3.7. -Flow design of utilization of P3.7. -The designed flow to keep the Services to adolescents
services to keep the waiting time waiting time short is followed. The are ideally provided
short and informative is in place. waiting time is filled in by holding within 30 minutes of their
informative sessions arrival in the facility.
Implementation Guide:

3.1 Ambiance of the facility. The facility should:

 Provide comfortable seating with proper ventilation, good lighting, fans, and
reading/information materials.
 Provide access to clean drinking water and clean toilets. A separate toilet for female
should be provided
 Provide appealing reference (posters, audio-video, reading) material for the
adolescent to browse through while waiting.

For a stand alone clinic: The clinic within the facility should be located preferably in a
separate room that provides the needed privacy so that the adolescents are comfortable in
accessing services from it

This set-up will ensure that the facility is appealing to adolescents. This will also make
the adolescents feel comfortable while availing services in the facility.

3.2 Confidentiality and privacy policy. The confidentiality and privacy should include
provisions stating the mechanisms for registration, the filing and storage of records
(records keeping), access to these records (specifying the personnel who can access to
these records as well as protocols to follow if people outside of the health facility would
want to access records and information), general guidelines on non-disclosing
information regarding the patient, designated spaces for provider – client interaction to
provide audio-visual privacy, provision of barriers such as curtains, separate rooms, etc.

3.3. Ensuring confidentiality. Clients and their accompanying adults should be informed
about the measures to maintain confidentiality. Each client should have an envelop or
folder where their Medical records (ITRs), results of laboratory examinations or other
special procedures done, referrals and other pertinent documents are filed. These are filed
depending on a prescribed system (by numbers, family name, barangays, etc). As much
as possible, there should be a designated room with lock and key where these records
should be filed. If this is not possible, these records should be kept in a filing cabinet with
lock and key. There will be designated personnel with access to these records. They will
only be pulled out only if a client – provider interaction will occur or in any situation as
may be necessary. Personnel working outside the facility should have a written request if
they want to access to the clients’ records for purposes of research, follow up, etc. A
verbal/written consent of the client should be obtained before information contained in
their records will be disclosed to outside parties. The staff should not discuss the client’s
situation with non-concerned parties.

3.4. Ensuring privacy. Audio and visual privacy of the client must be maintained. As mush
as possible, there should be a separate room where provider – client interaction should
take place and where examinations such as pap smear, physical examination, etc should
be done. If it is not possible to provide a separate room, barriers such as curtains should
be provided. The provider should only attend to one client at a time not unless the clients
 request that they be counseled together with other clients with similar problems or with
friends/families/significant others. Specifically, the following must be observed:
 Ensure that the consultation and examination are done in a place where the interaction
between the health worker and the adolescent cannot be heard or seen by anyone else;
 Ensure that no interruption occurs when a consultation or examination is in progress
(like phone/text calls, signing papers, etc)
 Ensure that no needless delays occur;
 Ensure that the adolescent is clear about what to do (e.g. by labeling the different
rooms such as pharmacy, and providing clear instructions as to where to go, have a
lab test and when to come back for the results).

Examples: Privacy and Confidentiality

# 1 - “We will be spending some time to talk about Maria’s history, especially her immunization,
past illnesses and your concerns about her health. After that, I would like to spend some time
alone with Maria. After I have examined her, I will ask you in again and we can discuss my
assessment and our plans, any laboratory tests, treatments and follow-up plans. Is that all right
with you?”

# 2 – “First of all, I would like to say that whatever we talk about in this interview will be kept
strictly confidential. Do you understand what is meant by confidential Maria? Or would you want
me to explain it further? However, there are certain situations when we may have to break this
confidentiality –usually in the person's own interest. First is, if the person plans to hurt herself or
hurt others, if she has been abused, if she has engaged in a serious crime or any activity that
makes us believe that she could be in danger… in these situations, we will have to break
confidentiality. So Mrs. X please be assured that I will notify you if I need to. Is that all right with
you ?”

3.5. Providing service in a friendly and appropriate manner. Service providers should
view the adolescent as the primary patient. They should greet the adolescents and
accompanying adult when they enter the clinic. Their behavior should inspire confidence
in the adolescents. They should also offer a seat to the waiting clients if there are other
clients seeking consultation and availing of the services. They must get the initial
information from the client in an area designated for this purpose.

3.6 Adolescent involvement. As much as possible, adolescents should be involved in layout

of the room and for putting up posters and IEC material. The adolescents from the
catchment area should be involved in making decisions about the type of IEC material
that should be kept in the facility. Once they are in the facility, they may be asked about
the set-up of the facility, how equipment, materials and furniture can be arranged in such
a way that they will not be hesitant to interact with the health personnel. A suggestion
box on the manner by which services are provided can be placed in area in the facility

3.7. Ensuring a smooth patient flow. A schematic diagram showing the flow of activities
from admission to the different service providers including the approximate time it would
take to complete each transaction should be posted in strategic areas. All efforts to reduce
the waiting time to a minimum should be adopted.
Standard 4. “An enabling environment exists in the community for adolescents to seek and
utilize the health services that they need and for the health care providers to provide the needed
services”.

Rationale: In many situations, the community members are not aware of the importance of
providing health services to adolescents. At times, there is reluctance, reservations and even
opposition to ensuring access to such services. This deters not only adolescents from availing the
services but also the service providers from delivering the needed health services to adolescents.

This standard encompasses community actions including educational campaigns that are aimed
to increase the awareness of the community to the need and importance of providing health
services to adolescent including those that aim to improve the sexual and reproductive health of
adolescents. This standard seeks the assistance of individuals, agencies and organizations in the
community to assist in providing the resources needed to be able to deliver the services.

Input Criteria Process Criteria Output Criteria

I4.1. -A plan of activities (including P4.1. - Activities as per the Community members
community assemblies, meetings with plan are carried out are aware of provision
parents, group meetings and school of services and
visits,) to be carried out in the convinced about the
community to inform community benefits of providing
members about the benefits and adolescents with health
availability of services to adolescents is information and
in place. services.
I4.2. -Procedures to communicate with P4.2. -Service providers
all adults visiting the health facility the communicate effectively
benefits and availability of services to about the value of
adolescents are in place. providing health services
to adolescents and the type
of services available in
their interactions with adult
patients.
I4.3. -Plan to provide some health P4.3. -Activities as Adolescents receive
services and commodities to adolescents mentioned in the plan are services from NGOs,
by selected community members, carried out selected community
NGOs, outreach workers and members, outreach
adolescents themselves are in place.
workers and other
I4.4. -A plan to carry out advocacy for P4.4. -Activities in the plan
adolescents
support to provision of services for to seek support from the
adolescents from the Local Local Development Plan
Development Plan (LDP) exists. (LDP) are carried out.
Implementation Guide:

4.1 Activities to inform community members about the value of providing adolescents
with services. The community can be engaged in a variety of ways like seeking their
views, informing them about the benefits and availability of services to adolescents and
involving them in prioritizing the areas that need to be addressed. The energies of the
community members should be utilized in a variety of ways to create an enabling
environment. Community assemblies can be utilized to explain to the members of the
community the benefits that adolescents can derive from seeking services from the
facility. In schools, concerns of adolescents can be discussed during parent-teacher
meetings and the service providers can discuss the services that adolescents can avail of
depending on the issues and concerns that are presented in the meeting. Service providers
may visit schools during health fairs and have a booth that displays their services. In
these events, a health communication material developed by the facility and prepared in
the vernacular can also be distributed. Short meetings should be organized with women's
groups, self-help groups and other relevant sections and discussion about adolescent
vulnerabilities and availability of services should be discussed.

Advantage should be taken of fairs and other festivals where adolescents are expected to
gather in large numbers.

Folk media and mass media (TV, Radio, newspapers, magazines and web-based) should
be effectively engaged in generating awareness about issues that impact the health of
adolescents as well as for improving awareness regarding the availability of adolescent
friendly health services.

4.2 Communicating with other ADULTS visiting the facility about the value of
providing adolescents with services. All adults visiting the facility should be informed
of the current status of adolescent health in the community. IEC materials (comics,
leaflets) with the adults/parents as target audience can be given so that they will be
informed of the value of availing of the services of the facility whenever their adolescent
sons and daughters are in need of these services. Sessions with adults can also be done in
the health center/facility using a flipchart. Concerns of these adults/parents can also be
addressed in the open forum/question and answer part right after the education session.

4.3 Involving selected community members in providing health services/commodities. It

is necessary to identify different organizations, individuals, agencies in the community
who have adolescent care as their main area of concern or interest. These different
stakeholders should be involved in formulating plans for the provision or improvement of
services. This will enable them to identify their roles and contributions to the overall plan
for service provision to this special group. It is also an opportunity to forge partnerships
and devise procedures and mechanisms to ensure the smooth flow of service delivery.

Community members and organizations may also be involved in other activities such as
sportsfest, clean and green campaigns, and tree planting. The elected officials of the
community may also pass ordinances banning smoking and alcohol use among minors. In
 this way, adolescents can be productive and responsible members of the community. In
the event that there are adolescents that need to be rehabilitated, elected officials may
also be involved in community-based rehabilitation programs.

4.4 Advocating for support in the local development plan. A Task Force on adolescent
health can be created/established. Members of the task force would be representatives
from planning, budget, health, NGOs, social services, among others. Other approaches
should also be explored. The facility manager or focal person may present the services
being provided during meetings of the local health board. In this way, the representative
of the local health unit, together with the elected officials in the community will be
enlightened on the importance of providing services to adolescents. Meetings of the
school board are also another venue for generating support to the provision of health
services to adolescents. Local government units (LGUs) may develop resolution and pass
ordinances in support of adolescent health activities and programs.
 The Package of Services

This part of the document describes interventions organized in packages. The packages of
interventions are described for each level of facility and the essential commodities are identified
to assure adequacy and quality of care.

Package of Service Interventions at the Primary Key Supplies and Commodities Needed
Basic Level (RHU, Lying–in
Clinics)
 General Health  Writing materials, Individual
Essential Health Package Assessment – History Treatment Record Forms (ITR),
and Physical Exam  Dental mirror, Dental record form,
 Dental Assessment Dental Equipment
 Psychosocial Risk  Psychosocial Risk Assessment
Assessment and Form
Management  BP apparatus, Adult weighing
 Nutrition Assessment scale, tape measure, height chart,
and Counselling orchidometer, dietary prescription
 Micronutrient form, exchange list
Supplementation  Iron with folic acid tablets
 Immunization  Vaccines: Tetanus toxoid, MMR,
 Basic Diagnostic Tests Hepatitis B
 Reproductive Health  Centrifuge, heparinized capilet,
Assessment and microscope, syringes and needles,
Counselling cotton, alcohol, slides, cover slip,
vaginal speculum, cotton pledget
 ITR, Reproductive Health
Assessment Checklist, Flipchart on
reproductive health

Adolescent Pregnancy  Prenatal Services  ITR, FP flipchart, iron tablets,

Package  Natal Services blood typing and Rh sera,
 Post Natal Visits pregnancy test, centrifuge,
microscope, TT vaccine, syringes,
cotton balls, alcohol, FP
commodities
 HBsAg reagent, birth plan form,
NBS kit, BCG, Hepatitis B
vaccine, delivery table, sterile
scissors, gloves, cotton, alcohol,
plastic clamp, equipment and
supplies as per BEmONC
guidelines
 Iron tablets and vitamin A
capsules, FP flipchart, FP
commodities, Breastfeeding chart,
diet plan
Package of Service Interventions at the Referral Key Supplies and Commodities Needed
Facilities (District Hospitals,
Provincial, Tertiary
Facilities)
Sexually Transmitted  History and  ITR
Infections/HIV Packages Assessment

Package of Service Interventions at the Referral Key Supplies and Commodities Needed
Facilities (District Hospitals,
Provincial, Tertiary
Facilities)
Sexually Transmitted  Diagnostics  ITR
Infections/HIV Packages  Reagents for Gram’s stain, RPR,
Glass slides, microscope, cotton
pledgets
Basic Essential Health  Voluntary Testing for  Reagents for Gram’s stain, RPR,
Package HIV/STIs Glass slides, microscope, cotton
pledgets
Sexually Transmitted  Management,  Counselling Cards or Chart
Infections/HIV Packages Treatment and
Counseling

IV. Implementing Mechanisms at Various Levels

Different sectors and facilities are involved in the provision of adolescent-friendly health
services. Roles are outlined so that respective sectors and facilities are informed of what they
should do in catering to the needs of adolescents.

National Level (Department of Health):

 Formulate standards/policies/guidelines
 Develop communication plan on adolescent health
 Develop training manual for personnel rendering health services to adolescents
 Conduct capability-building activities for personnel involved in the provision of services
for the adolescents
 Coordinate with other agencies (GOs and NGOs) on the implementation of standards and
guidelines for health facilities
 Develop guidelines which are in line with the implementation of AFHS
 Mobilize resources for the implementation of adolescent health activities
 Conduct monitoring and evaluation activities

Center for Health Development (CHD) Level:

 Provide technical assistance to LGUs (plan preparation, materials development etc.)
 Disseminate guidelines to LGUs and other directives that may be circulated by the
Department of Health periodically
 Appoint focal person in the region who will be in-charge of the implementation of the
standards and implementation guide
 Organize a multi-sectoral technical working group in the region
 Formulate a region-wide plan on the implementation of standards and implementation
guide
 Establish a database of facilities in the region proving adolescent health services
 Monitor and evaluate the facilities providing services to adolescents in the provinces
under its jurisdiction

LGU (Provincial/Municipality/City) Level:

 Develop ordinances, resolutions in support of adolescent health
 Disseminate guidelines, protocols, policies and procedures which may be circulated by
the Department of Health in relation to the provision of health services to adolescents
 Provide support to adolescent health activities and advocacy efforts
 Network with various sectors
 Prepare report on the services utilized by the adolescents; commodities used and needed
to be replaced; personnel who provided services; and attended capability building
activities

Non-Government Organizations
 Utilize the standards and implementation guide in the provision of health services
 Provide services needed by adolescents within the capability of the organization
 Share good practices in the provision of services to adolescents

Professional Organizations
  Orient the members of the organization on the standards and implementation guide
 Disseminate the guidelines and other directives to its members that may be circulated by
the Department of Health periodically
 Act as technical resource group on adolescent health
 Participate in the conduct of orientation programs related to adolescent health

Academic Institutions
 Promote adolescent-friendly institutions
 Act as technical resource persons on adolescent health
 Develop adolescent-oriented programs and activities
 Orient the teachers and other personnel of the standards and implementation guide
 Refer adolescents to facilities that provide services to adolescents
 Conduct orientation programs to adolescents regarding the services which they can avail
from adolescent friendly health facilities

V. Monitoring and Evaluation of the AFHS Quality Standards

The AFHS quality standards will be monitored and evaluated in two ways:
1. Continuous monitoring of the AFHS package implementation
2. Periodic evaluation on compliance with the AFHS quality standards

The implementation of quality standards of AFHS will be monitored by the authorities. The
initial activity will be spearheaded by the National Technical Working Group (TWG) and will be
done six (6) months after the implementation of the standards and implementation guide. A bi-
annual monitoring will be conducted by the regional technical working group among the
facilities under its jurisdiction.

The evaluation on the compliance with the AFHS quality standards will be carried out in line
with Department of Health (DOH) guidelines. Tools contained in this document may be utilized
by various organizations and facilities in the monitoring and evaluation activities.

Monitoring Tool 1. Facility Observation Checklist

Standard 1. Adolescents in the catchment area of the facility are aware about the health services it provides and find
the health facility easy to reach and to obtain services from it.

Item Self Assessment Assessment Team Recommendations

Signages
Welcome Signage
Schedule of Clinic Hours
(Day and Time)
Health Services
Clinical Guidelines
Documents
Action Plan for
Information Dissemination
Policy regarding flexible
time schedule
Policies for provision of
services
Policies for payment
schemes
Plan for outreach program
Registration logbook
containing the list of
clients who consulted and
were given services

Standard 2 “The services provided by health facilities to adolescents are in line with the accepted package of health
services and are provided on site or through referral linkages by well-trained staff effectively”.

Item Self Assessment Assessment Team Recommendations

Documents
National Standards for
Adolescent Service Package
List of services provided by
the facility
Stock cards showing the
delivery and utilization of
medicines, commodities for
adolescent health care
Certificates of training on
the minimum training
courses prescribed by DOH
for adolescent focal persons
and other providers
Protocols and guidelines for
patient interaction
Clinical management
guidelines and Adolescent
Job Aid are available
Individual Treatment
Records that shows the chief
complaint, findings on
examination, clinical
impression and management
of clients
Directory of organizations –
name, address, services
provided, contact number
and contact person
Referral logbook – name,
age, address, Clinical
Impression, where referred,
reason for referral, result of
referral
Referral forms

Standard 3“The health services are provided in ways that respect the rights of adolescents and their privacy and
confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Item Self Assessment Assessment Team Recommendations
Facility
Patient flow from admission
to delivery of services
including the average time for
each step is posted in strategic
places.
A policy to ensure
confidentiality is posted.
Policies to ensure privacy is
posted
Individual records are kept in
separate envelopes.
All records are kept in a safe
place, preferably in a separate
room or a filing cabinet with
lock and key.
There is a designated person
with access to the records.
There are designated
admission and waiting areas.
There are separate rooms for
consultation, treatment and
counseling. If there are limited
rooms, there are at least
curtains to separate each
provider.
There is a suggestion box.
Conversation between
provider and client cannot be
heard by others.
There are peer educators
assisting in clinic operations
and providing services
(lectures, counseling, etc)
Materials being used by the
adolescents in the facility
Documents
SOP for maintenance of
facility
Policies and procedures to
ensure confidentiality
Policies and procedures to
ensure privacy
Protocol and procedures for
patient – provider interaction
Minutes of meetings of TWG

Standard 4. “An enabling environment exists in the community for adolescents to seek and utilize the health
services that they need and for the health care providers to provide the needed services”.

Item Self Assessment Assessment Team Recommendations

There are leaflets containing
the clinic schedule and
services which the
patients/community members
can bring home and share to
other community members.
IEC materials on the different
programs / services available
(Example IEC on maternal
care, family planning, etc).
The IEC materials should also
include the directory of other
agencies/organizations where
the services can be obtained.
Documents
IEC Plan
Copy of the Local
Development Plan
Advocacy Plan
Action Plan showing different
agency participation – the
name of the agency,
resources/assistance they will
provide, the person’s
responsible
Accomplishment report
showing the services given at
the public health facility as
well as those given by other
agencies, individuals and peer
counselors
 Monitoring Tool 2. Facility Manager Interview Questionnaire

Name of Facility:
Type of Facility:
Date of Assessment (dd/mm/yyyy)

Type of staff Number

Clinical-Total
o Medical doctors
o Nurses
o Midwife
Non-clinical-Total
o Psychologist, Counselors etc.
o Social workers
o Support staff (receptionist, cleaners, administrative clerks)
o Barangay Health Workers
Total

Criteria Yes No Remarks

Does the facility have the following signages
o Schedule of clinic hours for adolescents
o Services available
o Adolescents are Welcome
o “Services are Free of Charge”
Service Provision
Services provided
o Counseling
o Nutritional Assessment and counseling
o Maternal Care Services
 Pre natal
 Natal
 Post natal
o Services for STIs including HIV/AIDS
o FP Services
o Dental Assessment
o Micronutrient Supplementation
o Immunization – TT. Hepa B, MMR
o Reproductive Health Assessment and Counseling
 Fertility awareness , menstrual health issues and
counseling
 Pap smear and pelvic exams, if sexually active
 Adolescent male reproductive health issues
 Gender issues
o Health prevention and promotion
o Psychological Counseling
o Social and legal support
o Substance abuse
o Commodities and Supplies
o BP Apparatus
o Weighing Scale
o Tape measure
o Height chart
o Orchidometer
o Dietary prescription form
o Exchange list
o Vaccines – TT, MMR, Hepa B
o Disposable syringes
o Cotton
o Alcohol
o Centrifuge
o Heparinized capilet
o Microscope
o Slides
o HIV testing kit
o RPR
o Reagents for Gram stain
o Cotton pledgets
o NBS kit
o BCG vaccine
o Gloves
o Cord clamp
o Vit K injection
o Iron with folic acid tablets
o FP Commodities
o Writing materials
o Individual Treatment Records
o Dental Record Forms
o Referral Forms
o Feedback Form
Planning
Written Plan for:
o IEC Campaigns
o Promotion of adolescent health services and facility
o Outreach including schedule
Procedures and Policies
Standard Operating Procedures
o Maintaining good clinic ambience conducive to adolescents
o Provision of Free Services to Adolescents
o Procedures for Dealing with Adolescents
o Clinical Protocols for the different health and health related
programs and conditions
o Two way referral
o Ensuring privacy and confidentiality
Documentation
Ledgers for:
o Clients seen at the clinic
o Clients seen during outreach
o IEC activities done, topic and list of participants
o Results for feedback
o Results of supervisory visits
Adolescent Participation
o Feedback mechanism on the services provided
o Participation in the design, implementation and assessment
of the following services:
Monitoring and Evaluation
o Inventory of supplies and equipment
o Client satisfaction
o Clinical Case management
o Provider performance

Please List the Staff Members and check the Training specific for Adolescents they have received:

Name of Physician Nurse Midwife Psychologist Social

Training Worker
Orientation
Program on
Adolescent
Health
Adolescent
Job Aid
Others:
Specify
 Monitoring Tool 3. Service Provider Interview Questionnaire

Name of Provider:
Designation:

Service Delivery
1. When and what time is the facility open (Days and time)?
2. Is the facility open after office hours and weekends? If not, what mechanisms were put in
place to ensure that the adolescents get the services after office hours and during weekends?
3. What agencies provide these services?
4. How do you get information from these facilities regarding the clients that they serve/provide
services to?
5. What services are available in your facility? In other public health facilities (laboratories,
social hygiene clinics, etc)
6. What do you do when the services needed are not available in the facility?
7. How do you keep track of the outcome of these referrals?
8. Do you provide adolescents with appropriate information about treatments, procedures,
contraceptive methods, as well as counseling to make decisions?
9. Describe the flow of patients from admission to the time they leave the facility.
10. What mechanisms are in place to ensure:
a. Confidentiality
b. Privacy
11. Do you explain that services are confidential?

Financing
1. How much budget is given to the Adolescent Friendly Health Services?
2. What are the sources of budget to maintain operations of the facility?
3. Are the services given for free? If payment is made:
a. How much?
b. How did you come up with the amount?
c. How are the funds handled (liquidation, disbursement, accountability)
4. Are there financing schemes available? If yes, what are they?

Regulations
1. What are the national and local policies/laws/ statutes enacted in support of Adolescent
Friendly Health Care and Facilities?
2. What policies and procedures have been formulated by the facility to govern operations and
service delivery?

Governance
1. Is monitoring and supervision conducted? If yes,
 a. How often?
b. By Whom?
c. What are the results?
d. How long will it take to implement the recommendations made?
If no, Why do you think so?
2. Are you trained on Adolescent Reproductive Health? If yes, what training course did you
attend? If no. Why?

Recommendations: What would you recommend to improve the following?

1. Physical structure and appearance of the facility
2. Clinic procedures including patient flow and waiting time
3. Measures to ensure
a. Confidentiality
b. Privacy
4. Capability of staff to deal with adolescents and address their needs
5. Training. Are there any other training you would want to recommend aside from those
required by DOH
6. Staff capability in dealing with adolescents
7. Referral
8. Information dissemination
9. Adolescent participation
10. Community participation
 Monitoring Tool 4. Client (Adolescent) Interview Questionnaire

1. What is the schedule of operations of the facility?

2. Can you enumerate the services offered in the facility that you know of?
3. Can you please describe the process from admission to the time you leave the facility?
4. How did you come to know about this facility and the services they offer?
5. What are the features that would ensure:
a. Confidentiality
b. Privacy
6. What mechanisms are in place to solicit your opinion regarding the facility and improving its
condition and operations?
7. Give your comments on the following:
a. Facility
b. Admission
c. Waiting time
d. Services
e. Staff
f. Availability of needed supplies and commodities
8. What is your overall rating of the facility and its operations?
9. What are your recommendations/suggestions to improve the facility and its operations?
 References

A Practical Guide on Adolescent Health Care, Department of Health and UNFPA, _________

Adolescent Friendly Health Services: An Agenda for Change. Geneva. WHO, October 2002

Adolescent Friendly Reproductive Health Services Network Operations Manual. Philippines.

Save the Children. _________.

Department of Health. Guide Book on Adolescent and Youth Health and Development Program.
DOH, Philippines. 2002.

Department of Health. Manual of Standards for Adolescent Friendly Health Services. DOH,
Philippines. 2008.

Dickson, K., Ashton, J, and Smith, J. Do setting adolescent-friendly standards improve quality of
care in clinics? Evidence from South Africa. International Journal for Quality in Health Care.
Oxford University Press. 1-10. 2007.

Implementation Guide on RCH II: Adolescent Reproductive Sexual Health Strategy: India. May
2006.

Marquez, L. 2001. Helping Healthcare Providers Perform According to Standards. QA

Operations Research Issue Paper 2 (3): 3-30.

National Consultation on RCH II ARSH Strategy: A Report. New Delhi. September 2005

National Demographic Health Survey 2008, Philippines. December 2009.

National Standards for Provision of Youth Friendly Health Services in Bhutan (Draft National
Standards and Implementation Guide. May 2008.

National Standards and Implementation Guide for Youth Friendly Health Services: Bhutan. May
2008

National AIDS Registry, Department of Health National Epidemiology Center (Data from
January to October 2009).

Package of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and
Child Care, WHO, 2010.
Quality Standards of Youth Friendly Health Services in the Republic of Moldova. Moldova.
2009

Workshop Output. Workshop on the Development of Standards of Adolescent Friendly-Health

Services, Tagaytay City. August 2009

Youth Friendly Health Services (YFHS) standards, criteria, actions to achieve criteria, means of
verification. Bangladesh. April 2005.
 Annex 1. Laws and Issuances on the Provision of AFHS in the Philippines

International Issuances

1. Committee on the Rights of the Child General Comment No. 4

2. Convention on the Elimination of All Forms of Discrimination Against Women
(CEDAW)
3. Beijing Platform For Action (BPFA)
4. Article 6 of the United Nations Convention on the Rights of the Child

National Issuances

1. Republic Act 7610: Special Protection of Children Against Child Abuse,

Exploitation and Discrimination Act

2. Republic Act 9231: Worst Form of Child Labor

3. Republic Act 9710: The Magna Carta of Women
4. Republic Act 8504: Philippine Aids and Control Act of 1998
5. Article 54 of the Civil Code of the Philippines

6. P.D. 603: Child and Youth Welfare Code of 1974

7. R.A. 9262: Anti-Violence Against Women and their Children Act of 2004

8. R.A. 9211 (Tobacco Regulation Act of 2003)

9. R.A. 9165 (Comprehensive Dangerous Drugs Act of 2002)

10. DOH Administrative Order (AO) 34 – A series of 2000

 Annex 2. The Process of Developing National Standards
on Adolescent Friendly Health Services

A Strategic Planning Workshop for Accelerating Action for Adolescent and Youth Health was
conducted from September 23-26, 2008 in Pranjetto Hills Hotel in Tanay, Rizal. Gaps and
critical activities for Adolescent and Youth Health were identified. In the same year (2008), the
Framework for the Adolescent Health Strategic Plan was started and finished in 2009.

A Workshop on the Development of National Standards for Adolescent-Friendly Health Services

was organized by the Department of Health, Philippines with the support of the WHO Regional
Office for the Western Pacific in Tagaytay City from 4 to 7 August 2009. The intended
beneficiaries of this workshop are all adolescents (10-19) in the Philippines. This workshop was
organized to build wide consensus and to develop a set of standards to ensure the provision of
good quality adolescent health services at the different levels of care, to respond appropriately to
adolescent health needs.

The workshop was guided by the principles that AHFS should:

 Respect, fulfill and protect the rights of adolescents
 Comply with accepted standards of medical ethics in the delivery of services
 Given due consideration to national laws and policies and the socio-cultural context
 Ensure access to comprehensive and holistic services
 Provide adequate attention to the different needs of adolescents
 Ensure young people’s privacy and confidentiality
 Ensure adolescent’s participation at all levels
 Provide evidenced-based services
 Promote community ownership and active involvement of all stakeholders including parents
and community members, and
 Link with other sectors

To build wide ownership and shared understanding, the workshop brought together a range of
stakeholders from the government (from national, regional, provincial and city/municipal levels),
local non-governmental organizations (NGOs) working with adolescents, international NGOs
and United Nations agencies (United Nations Children's Fund [UNICEF], UNFPA and WHO)
and participants from Cambodia. Fifty-five participants attended the opening session of the
workshop.

The workshop utilized a mix of methods including interactive sessions, small group discussions,
brainstorming, VIPP, and plenary presentations. The participants discussed and finalized the
health outcomes to be achieved, the package of services to help achieve the agreed upon health
outcomes, service delivery points from where the services should be provided and the service
providers who will provide the said services to adolescents. Four "standards" were developed by
this consultative process.

Annex 3. Guiding Principles

All efforts to establish facilities and services that are friendly to adolescents are in line with the
right of the adolescent to the highest attainable standard of health. The UN Committee on
Economic, Social and Cultural Rights has said that the right to health consists of six normative
elements:
1. Health availability refers to the availability of a sufficient number of functioning public
health and health care facilities, goods, services, programs and underlying determinants of
health.
2. Health physical accessibility means that all health facilities, centers, programs and goods
must be within safe physical reach for all, and includes timely access to health services.
Physical access also requires the construction of access paths to buildings and other public
places for persons with disabilities.
3. Health economic accessibility means that the costs of availing health services, goods, and
facilities and the underlying determinants of health must be based on the principle of equity
and must be affordable for all.
4. Health information accessibility refers to the right to seek, receive and impart information
and ideas regarding health issues and concerns. Health information accessibility, however,
does not in any way impair the individual’s right to privacy and confidentiality of personal
health data. The Committee on the Rights of the Child urges the active involvement of
adolescents in the design and dissemination of health information through a variety of
channels beyond the school, including youth organizations, religious, community and other
groups and media.
5. Health acceptability means that health services, goods and facilities and underlying
determinants of health must respect medical ethics, be culturally appropriate, be sensitive to
gender and life-cycle requirements, respect confidentiality of personal health data, and must
be designed to improve everyone’s health status.
6. Health quality means that all health goods, services, facilities and underlying determinants of
health must be scientifically and medically sound and of good quality.
 Annex 4. Standard and Criteria Definitions

A standard is a statement of desired quality. In some countries, standards for ensuring the
performance of health facilities for adolescents have been developed. These standards strengthen
program implementation as well as monitoring, supervision and evaluation by setting clear
performance goals, defining the quality required for a service and providing a clear basis against
which performance can be monitored, assessed and / or compared.

The key “friendly” characteristics of services for adolescent are viewed from the perspectives
of the users, providers and health system.

From the users’ perspective, health services must be:

 Accessible: ready access to services is provided

 Acceptable: health care meets the expectations of adolescents who use the services
 Gender-sensitive: there shall be no discrimination, services must be given regardless of
orientation
 Culturally-appropriate: services must not run counter to existing value systems
 Rights-based: in all aspects of program implementation, the promotion of young people’s
rights shall be applied.

From the providers’ / managers’ perspective, health services must be:

 Age-appropriate: required care is provided ; unnecessary and harmful care is avoided
 Comprehensive: care provision covers aspects for prevention through counseling to
treatment
 Effective: health care produces positive change in the health status of the adolescent. The
health system should focus on the efficiency in the health system, that is providing high
quality care at the lowest possible cost
 Equitable: services are provided to all adolescents who need them especially the poor,
marginalized, vulnerable and difficult to reach groups.
 Annex 5. Adolescent and Youth Health Program Technical Committee

Adolescent and Youth Health Program

Technical Committee
Dr. Juanita A. Basilio FHO
Dr. Manuel Calonge FHO
Ms. Lita Orbillo FHO
Ms. Onofria de Guzman FHO
Mr. Raymond Mazo FHO
Ms. Lyra Gay Borja FHO
Ms. Jill Alvarez FAD
Ms. Ma. Loida Sevilla PLAN
Atty Mylen Gonzales Child Justice
Ms. Pamela Marie Averion UNFPA
Ms. Lauren Musa CWC
Dr. Mariella Castillo WHO, Country Office
Dr. Howard Sobel WHO, Country Office
Dr. Patanjali Nayar WHO-WPRO
Ms. Gudrun Nadoll UNICEF
Dr. Rosa Maria Nancho SAMPI
Mr. Melvin Dayrit DSWD
Ms. Maribeth Casin BWYW, DOLE
Ms. Myrna V. Santos NBOO-DILG
Mr. Robin Espinosa NYC
Ms. Loida Ramos HNC,DepEd
Dr. Gerald Belimac IDO
Dr. Olga Virtucio AFRHS Network
Dr. Esther Oliveros AFRHS Network
Ms. Socorro Baluyot CHD-MM
Dr. Lani Samonte Save the Children
Ms. Maristela Abenojar PNA
Ms. Edna Nito NCHP
Ms. Frances Rose Elgo HPDPB
 Annex 6. Workshop Participants, August 3-7, 2009, Tagaytay City, Philippines

Juanita A. Basilio, M.D Family Health Office-National Center for Disease

Rudy Albornoz Prevention and Control, Department of Health
Lita Orbillo (FHO, NCDPC, HOH)
Maristela P. Abenojar Philippine Nurses Association (PNA)
Jill S. Alvarez FAD, Inc.
Elmer M. Angus, M.D Philippine Academy of Physicians in School Health,
Inc.
Pamela Averion UNFPA, Gender & Culture and ARH
Marciano Fidel Avendaño Private School Health Officers Association
Medalla P. Balandra DOH-CHD Western Visayas
Ma. Socorro R. Baluyut DOH-CHD-MM
Edna A. Beguia IMAP, Inc.
Ma. Maila C. Bernabe DOH-CHD Western Visayas
Marifel S. Bogabel Save The Children
Deborah B. Cabanag NAPC Youth & Students
Hamilton Calderon FHO, Department of Health
Marlene de Castro Baguio Center for Young Adults, Inc.
Venkatraman Chandra-Mouli World Health Organization
Adolescent Health and Development
Department of Child and Adolescent Health and
Development
Jonathan D. Chua NAPC-YSSSC
Gloria Cirineo AFRHS Network
Mick Creati Burnett, Australia
Dr. Reinhard M. Dalumpines Department of Health
Center for Health Development/Family Health Cluster
Melvin C. Dayrit DSWD Central Office
Social Technology Bureau
Erlyn Della-Caparro, M.D. Society of Adolescent Medicine of the Philippines, Inc.
(SAMPI)
Moses de Guzman SAMPI
Marlyn Endozo TUCP
Robinson F. Espinoza National Youth Commission
Denia Gamboa Council for the Welfare of Children
Dexter M. Garcia TRIDEV Specialists Foundation
Brayant Gonzales Family Planning Organization of the Philippines
Chetra Kaeoun National Center for HIV/AIDS, Dermatology, and STD,
Ministry of Health, Cambodia
Ma. Evelyn Q. Lleno DOH –HHRDB
Susan Yanga Mabunga UP College of Public Health
Dr. Arvin Marbibi AFRHS Network
Robert T. Mendoza Philippine League of Government and Private Midwives,
Inc.
Raquel Montejo DOH – Davao
Ma. Doreen Era E. Murata UNFPA – Youth Advisory Panel
Gudrun Nadoll United Nations Children’s Fund
Philippine Country Office
Dr. Rosa Maria H. Nancho PGH-Society of Adolescent Medicine of the
Philippines, Inc. (SAMPI)
Dr. Virginia L. Narciso CHD-CAR
Baguio City
Dr. Gloria A. Narvaez CHD-4A
Dr. Patanjali Dev Nayar World Health Organization (WPRO)
Joyce E. Ocampo CHD 3
Fe b. Paler DOH-CHD Northern Mindanao
Valerie M. Pascual CHD 4A
Mylene Mirasol C. Quiray POPCOM
Dr. Luz P. Revita Philippine Academy of Physicians in School Health, Inc.
(PAPSHI)
Lynny A. Sarigumba, CHO – Bislig City LGU
Ma. Loida Y. Sevilla Plan International, Philippines
Cristina V. Sison CHD-4B
Dr. Howard Sobel Office of the WHO Representative
Dr. Srun Sok The Ministry of Health
Department of Hospital Services
Cambodia
Lucita O. Tagudin DOH-Caraga
Dr. Marianna Trias World Health Organization (WPRO) Child and Adolescent
Health
Gloria Villena Dr. Jose Fabella Memorial Hospital
Dr. Olga Virtusio City Health Office, Paranaque City